DOCSLIB.ORG

Assessment and Management of Foot Ulcers for People with Diabetes Second Edition Disclaimer

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Assessment and Management of Foot Ulcers for People with Diabetes Second Edition Disclaimer Clinical Best Practice Guidelines MARCH 2013 Assessment and Management of Foot Ulcers for People with Diabetes Second Edition Disclaimer These guidelines are not binding on nurses or the organizations that employ them. The use of these guidelines should be flexible, and based on individual needs and local circumstances. They neither constitute a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Copyright With the exception of those portions of this document for which a specific prohibition or limitation against copying appears, the balance of this document may be produced, reproduced and published in its entirety, without modification, in any form, including in electronic form, for educational or non-commercial purposes. Should any adaptation of the material be required for any reason, written permission must be obtained from the Registered Nurses’ Association of Ontario. Appropriate credit or citation must appear on all copied materials as follows: Registered Nurses’ Association of Ontario (2013). Assessment and Management of Foot Ulcers for People with Diabetes (2nd ed.). Toronto, ON: Registered Nurses’ Association of Ontario. This work is funded by the Ontario Ministry of Health and Long-Term Care. Contact Information Registered Nurses’ Association of Ontario 158 Pearl Street, Toronto, Ontario M5H 1L3 Website: www.rnao.ca/bestpractices Assessment and Management of Foot Ulcers for People with Diabetes Second Edition Assessment and Management of Foot Ulcers for People with Diabetes, Second Edition Greetings from Doris Grinspun, Chief Executive Officer, Registered Nurses’ Association of Ontario The Registered Nurses’ Association of Ontario (RNAO) is delighted to present the second edition of the clinical best practice guideline, Assessment and Management of Foot Ulcers for People with Diabetes. Evidence-based practice supports the excellence in service that health professionals are committed to delivering every day. RNAO is pleased to provide you with this key resource, selected by the Council of the Federation for national implementation. We offer our heartfelt thanks to the many stakeholders that are making our vision for Best Practice Guidelines (BPG) a reality: the Government of Ontario, for recognizing RNAO’s ability to lead the program and for providing multi-year funding; Drs. Irmajean Bajnok and Monique Lloyd, Director and Associate Director (respectively) of the RNAO International Affairs and Best Practice Guidelines (IABPG) Centre, for their expertise and leadership in advancing the development of BPGs; and Expert Panel Chair Laura Teague, Wound Specialist at Saint Michael’s Hospital in Toronto, Canada, for her exquisite expertise and stewardship of this guideline. Thanks also to RNAO staff Rishma Nazarali, Sarah Xiao, Anastasia Harripaul and Andrea Stubbs, for their intense work in the production of this second edition. Special thanks to the entire BPG Expert Panel for generously providing time and expertise to deliver a rigorous and robust clinical resource. We couldn’t have done it without you! The nursing and health-care community, with their unwavering commitment and passion for excellence in patient care, have provided the expertise and countless hours of volunteer work essential to the development and revision of each guideline. Employers have responded enthusiastically by nominating best practice Champions, implementing guidelines, and evaluating their impact on patients and organizations. Governments at home and abroad have joined in this journey. Together, we are building a culture of evidence-based practice. Successful uptake of BPGs requires a concerted effort from educators, clinicians, employers, policy makers and researchers. After lodging the evidence into their minds and hearts, knowledgeable and skillful health professionals and students need healthy work environments to enable guideline use and practice changes. We ask that you share this guideline with members of the interprofessional team, as there is much to learn from one another. Together, we must ensure that the public receives the best possible care every time they come in contact with us – making them the real winners in this important effort! Doris Grinspun, RN, MSN, PhD, LLD (Hon), O. ONT. Chief Executive Officer Registered Nurses’ Association of Ontario 2 REGISTERED NURSES’ ASSOCIATION OF ONTARIO Assessment and Management of Foot Ulcers for People with Diabetes, Second Edition Greetings from Vasanthi Srinivasan and Susan Williams, Lead ADMs, Council of the Federation, Clinical Practice Guidelines Working Group At their Council of the Federation meeting in January 2012, provincial and territorial Premiers launched a series of new initiatives designed to encourage collaboration and cooperation on health care innovations across the country. Premiers received the first report from the Health Care Innovation Working Group co-chaired by PEI Premier Ghiz and Saskatchewan Premier Brad, and directed their Ministers of Health to come together and work closely with national and regional health professional organizations to ensure that Vasanthi Srinivasan Susan Williams Canadians have access to the best quality health care in the world. While Premiers acknowledged that Canada’s provinces and territories are pursuing innovation in their own jurisdictions, they recognized that more transformative, lasting change can be achieved together. As part of this new initiative, Premiers asked Ontario and Alberta to co-lead work on accelerating the adoption of key clinical best practice guidelines across the country. Premiers want to ensure that all Canadians benefit from up to date, evidence-based guidance, regardless of where in Canada it is developed. So, after consulting with government health officials, major health professional groups including CMA, CNA/RNAO, HEAL, and many other relevant experts, provincial and territorial Ministers of Health recommended to their Premiers the wide adoption of two guidelines for the initial phase of this pan-Canadian work. One of these two guidelines was the Registered Nurses’ Association of Ontario (RNAO) Assessment and Management of Foot Ulcers for People with Diabetes. Ensuring quality health care requires access to high-quality, regularly updated advice for patient care. The RNAO’s Nursing Best Practice Guidelines Program provides Premiers with exactly the level of scientific rigour they are looking for, combined with the accessibility and usability needed to quickly spread the guideline to nursing practitioners and other health professionals across the country. Given Canada’s aging population and rising rates of diabetes, our health systems will increasingly depend on resources like the RNAO’s Assessment and Management of Foot Ulcers for People with Diabetes guideline to manage demands for these important health care services. We would like to thank RNAO for their hard work and leadership in transforming evidence into action. This ongoing commitment is helping to ensure quality health care for all Canadians. Co-Leads Clinical Practice Guidelines Working Group, Health Care Innovation Working Group Vasanthi Srinivasan Susan Williams Assistant Deputy Minister Assistant Deputy Minister Ontario Ministry of Health and Long-Term Care Alberta Health BEST PRACTICE GUIDELINES • www.RNAO.ca 3 Assessment and Management of Foot Ulcers for People with Diabetes, Second Edition Table of Contents How to use this Document . 6 Purpose and Scope . 7 Summary of Recommendations . 8 Interpretation of Evidence . 11 Panel Members . 12 BACKGROUND RNAO Best Practice Guideline Program Team . 13 Stakeholder Acknowledgement . 14 Background Content . 15 Practice Recommendations . 18 Education Recommendations . 49 Organization and Policy Recommendations . 50 Research Gaps and Future Implications . 53 Evaluation/Monitoring of Guideline . 54 RECOMMENDATIONS Implementation Strategies . 59 Process for Guideline Update/Review of Guideline . 61 Reference List . 62 Bibliography . 75 REFERENCES 4 REGISTERED NURSES’ ASSOCIATION OF ONTARIO Assessment and Management of Foot Ulcers for People with Diabetes, Second Edition Appendix A: Glossary of Terms . 100 Appendix B: Guideline Development Process . 105 Appendix C: Process for Systematic Review/Search Strategy . 106 Appendix D: University of Texas Foot Classification System – Categories 4-6: Risk Factors for Amputation . 109 Appendix E: University of Texas Foot Classification System – Categories 0-3: Risk Factors for Ulceration . 110 Appendix F: University of Texas Health Science Center San Antonio Diabetic Wound Classification System . 112 Appendix G: PEDIS: Diabetic Foot Ulcer Classification System . 113 Appendix H: Description of Foot Deformities . 117 Appendix I: Diagnostic Tests to Determine Vascular Supply . 123 Appendix J: Wound Swabbing Technique . 127 APPENDICES Appendix K: Use of the Semmes-Weinstein Monofilament . 128 Appendix L: Suggestions for Assessing and Selecting Shoes and Socks . 129 Appendix M: Offloading Devices . 130 Appendix N: Clinic Assessment Tool . 134 Appendix O: Optional Treatment Modalities . 138 Appendix P: Debridement Decision-Making Algorithm . 143 Appendix Q: Topical Antimicrobial Agents
Load more

Recommended publications
  • Arterial Leg Ulcer Clinical Pathway
    Waterloo Wellington Integrated Wound Care Program Evidence-Based Wound Care Arterial Leg Ulcer Clinical Pathway 0-7 Days Expected Outcomes Notes Most Responsible Physician(MRP)/Nurse Practitioner (NP) Refer patient to ‘Care Connects’ if no responsible practitioner currently involved with patient identified/informed Determine if MRP/NP is part of Family Health Team (FHT) or Community Health Centre (CHC) and consider additional supports available Medical/surgical history and co-morbidity management Risk factors include: Chronic renal disease considered within care plan Smoking Congestive heart failure Diabetes mellitus Impaired liver function Hyperlipidemia Use of systemic steroids, Hypertension immunosuppressive and chemotherapy Coronary artery disease >70 years of age History of cerebral vascular accident Age 50-69 years with history of diabetes (CVA) or smoking Low hemoglobin < 50 years with diabetes and one other Obesity atherosclerotic factor Poor nutrition History of vascular surgery or deep vein Decreased thyroid function thrombosis Psoriasis Bleeding disorders Autoimmune diseases Family history of arterial disease Medication reconciliation and their impact on wound healing Prescription, non-prescription, naturopathic and illicit drug use (including e-cigarettes, reviewed inhaled substances and nicotine replacement therapy) Medications that can affect healing include: chemotherapy, anticoagulants, antiplatelets, corticosteroids, vasoconstrictors, antihypertensives, diuretics and immunosepressive drugs Other
    [Show full text]
  • The Triangle of Wound Assessment a Simple and Holistic Framework for Wound Management
    The Triangle of Wound Assessment A simple and holistic framework for wound management Wound bed WOUND Wound edge Periwound skin We asked healthcare professionals around the world about their priorities ? for wound care We found that most people Respondents said that treating wounds are not protecting the periwound specialists in a hospital1 skin is very important1 Approximately Up to 79% of wounds are 70% of being treated in wounds are the community2 surrounded by unhealthy skin3 2 ...none However, in a recent met all of the study of 14 wound criteria for assessment tools ... optimal wound assessment4 The Triangle of Wound Assessment is a holistic framework that allows practitioners üto assess and manage all areas of the wound, including the periwound skin. It is a simple and systematic approach that guides the user Wound bed from complete wound WOUND assessment to setting management goals, and Wound edge Periwound skin selecting the optimal treatment. 3 The Triangle of Wound Assessment offers a systematic approach to wound management Optimal wound management starts with a holistic wound assessment. This will help to more efficiently set management goals, which will increase the potential for better treatment outcomes. Assessment Management Goals Treatment 4 This is achieved through a holistic framework The Triangle of Wound Assessment provides a framework to assess all three areas of the wound while remembering the patient behind the wound within their social context. Patient Wound bed Social context WOUND Wound Wound edge Periwound skin 5 It’s not just about the wound but also the patient behind the wound Optimal management of the wound starts with assessing the patient behind the wound, and the social context in which the patient lives.
    [Show full text]
  • Guideline: Wound Bed Preparation for Healable and Non Healable Wounds
    British Columbia Provincial Nursing Skin and Wound Committee Guideline: Wound Bed Preparation for Healable and Non Healable Wounds Developed by the BC Provincial Nursing Skin and Wound Committee in collaboration with Wound Clinicians from: / TITLE Guideline: Wound Bed Preparation for Healable and Non-Healable Wounds in Adults & Children1 Practice Level Nurses in accordance with health authority and agency policy. Conservative sharp wound debridement (CSWD) is a restricted activity according to the Nurse’s (Registered) and Nurse Practitioner Regulation. 2 CRNBC states that registered nurses must successfully complete additional education and follow an established guideline when carrying out CSWD. Biological debridement therapy is a restricted activity according to the Nurse’s (Registered) and Nurse Practitioner Regulation. 3 CRNBC states that registered nurses must follow an established guideline when carrying out biological debridement. Clients 4 with wounds needing wound bed preparation require an interprofessional approach to provide comprehensive, evidence-based assessment and treatment. This clinical practice guideline focuses solely on the role of the nurse, as one member of the interprofessional team providing care to these clients. Background Factors affecting wound healability include the presence of adequate circulation in the area of the wound, wound related factors such as the size and duration of the wound, the ability to treat the cause of the wound and the presence of risk factors impacting wound healing. While many wounds heal, others are determined to be non-healing or slow-to-heal based on the presence or absence of these factors. Wound healability must be determined prior to debridement and moist wound healing. Although wound healing normally occurs in a predictable fashion, wound healing trajectories can be heterogeneous and non- uniform resulting is delayed wound healing for some clients.
    [Show full text]
  • A Focus on the Triangle of Wound Assessment — Addressing the Gap Challenge and Identifying Suspected Biofilm in Clinical Practice
    Clinical practice A focus on the Triangle of Wound Assessment — addressing the gap challenge and identifying suspected biofilm in clinical practice Authors: Wound assessment should be comprehensive, systematic and evidence- Caroline Dowsett, Terry Swanson and Tonny Karlsmark based (World Union of Wound Healing Societies [WUWHS], 2016a). The Triangle of Wound Assessment offers clinicians a framework to assess the patient and their wound, taking into consideration the wound bed, wound edge and periwound skin (Dowsett et al, 2015). The framework can be adapted to incorporate new developments and new challenges in wound care such as the ‘gap challenge’ and biofilm prevention and management. Using the framework can assist in determining the status of the wound bed and support clinical decision making to prevent problems associated with exudate pooling at the wound bed and the potential for biofilm formation. he Triangle of Wound Assessment This article will discuss how the Triangle of was established in 2014 and provides Wound Assessment identifies infection and T a systematic approach to wound biofilm, tackles the gap challenge, and how assessment and in setting management goals, this framework can be developed for new to guide optimal treatment choice (Dowsett et challenges in wound care. al, 2015), ensuring that the periwound skin is incorporated into the assessment. Periwound The importance of holistic assessment skin can be a significant problem in patients Wounds are a significant source of cost to with chronic wounds, with between 60–70% patients, as well as to the health economy. of wounds found to be surrounded by either Chronic wounds are often hard to heal problematic or unhealthy periwound skin resulting in a cycle of pain, anxiety and (Cartier et al, 2014).
    [Show full text]
  • Clinician Assessment Tools for Patients with Diabetic Foot Disease: a Systematic Review
    Journal of Clinical Medicine Review Clinician Assessment Tools for Patients with Diabetic Foot Disease: A Systematic Review Raúl Fernández-Torres 1 , María Ruiz-Muñoz 1,* , Alberto J. Pérez-Panero 1 , Jerónimo C. García-Romero 2 and Manuel Gónzalez-Sánchez 3 1 Department of Nursing and Podiatry, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación Campus de Teatinos, 29071 Málaga, Spain; [email protected] (R.F.-T.); [email protected] (A.J.P.-P.) 2 Medical School of Physical Education and Sports, University of Málaga, C/Jiménez Fraud 10. Edificio López de Peñalver, 29010 Málaga, Spain; [email protected] 3 Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos, 29071 Málaga, Spain; [email protected] * Correspondence: [email protected]; Tel.: +34-951953215 Received: 10 April 2020; Accepted: 12 May 2020; Published: 15 May 2020 Abstract: The amputation rate in patients with diabetes is 15 to 40 times higher than in patients without diabetes. To avoid major complications, the identification of high-risk in patients with diabetes through early assessment highlights as a crucial action. Clinician assessment tools are scales in which clinical examiners are specifically trained to make a correct judgment based on patient outcomes that helps to identify at-risk patients and monitor the intervention. The aim of this study is to carry out a systematic review of valid and reliable Clinician assessment tools for measuring diabetic foot disease-related variables and analysing their psychometric properties. The databases used were PubMed, Scopus, SciELO, CINAHL, Cochrane, PEDro, and EMBASE. The search terms used were foot, ankle, diabetes, diabetic foot, assessment, tools, instruments, score, scale, validity, and reliability.
    [Show full text]
  • Assessment and Management of Pressure Injuries for the Interprofessional Team Third Edition Disclaimer
    Clinical Best Practice Guidelines MAY 2016 Assessment and Management of Pressure Injuries for the Interprofessional Team Third Edition Disclaimer Th ese guidelines are not binding on nurses, other health care professionals, or the organizations that employ them. Th e use of these guidelines should be fl exible, and based on individual needs and local circumstances. Th ey neither constitute a liability nor discharge from liability. While every eff ort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury, or expense arising from any such errors or omissions in the contents of this work. Copyright With the exception of those portions of this document for which a specifi c prohibition or limitation against copying appears, the balance of this document may be produced, reproduced, and published in its entirety, without modifi cation, in any form, including in electronic form, for educational or non-commercial purposes. Should any adaptation of the material be required for any reason, written permission must be obtained from RNAO. Appropriate credit or citation must appear on all copied materials as follows: Registered Nurses’ Association of Ontario (2016). Assessment and Management of Pressure Injuries for the Interprofessional Team, Th ird Edition. Toronto, ON: Registered Nurses’ Association of Ontario. Th is work is funded by the Ontario Ministry of Health and Long-Term Care. All work produced by RNAO is editorially independent from its funding source.
    [Show full text]
  • (RNAO) – Risk Assessment & Prevention of Pressure Ulcers
    Revised March 2005 Nursing Best Practice Guideline Shaping the future of Nursing Risk Assessment & Prevention of Pressure Ulcers Greetings from Doris Grinspun Executive Director Registered Nurses’ Association of Ontario It is with great excitement that the Registered Nurses’ Association of Ontario disseminates this revised nursing best practice guideline to you. Evidence-based practice supports the excellence in service that nurses are committed to deliver in our day-to-day practice. The RNAO is committed to ensuring that the evidence supporting guideline recommendations is the best available, and this guideline has been recently reviewed and revised to reflect the current state of knowledge. We offer our endless thanks to the many institutions and individuals that are making RNAO’s vision for Nursing Best Practice Guidelines (NBPG) a reality. The Government of Ontario recognized RNAO’s ability to lead this program and is providing multi-year funding. Tazim Virani – NBPG program director – with her fearless determination and skills, is moving the program forward faster and stronger than ever imagined. The nursing community, with its commitment and passion for excellence in nursing care, is providing the knowledge and countless hours essential to the creation, evaluation and revision of each guideline. Employers have responded enthusiastically by getting involved in nominating best practice champions, implementing and evaluating the NBPG and working towards an evidence-based practice culture. Now comes the true test in this phenomenal journey: will nurses utilize the guidelines in their day-to-day practice? Successful uptake of these NBPG requires a concerted effort of four groups: nurses themselves, other healthcare colleagues, nurse educators in academic and practice settings, and employers.
    [Show full text]
  • Best Practice Recommendations for T
    CLINICAL PRACTICE Best Practice Recommendations for Preparing the Wound Bed: Update 2006 BY R. Gary Sibbald, MD, FRCPC; Heather L. Orsted, RN, BN, ET, MSc; Patricia M. Coutts, RN; and David H. Keast, MSc, MD, FCFP Abstract This article updates the concept of Preparing the wound bed by intended for translation into practice. considering the whole patient (treatment of the cause and patient- This update of the Preparing the wound bed approach has the benefit centred concerns) before treating the wound. Local wound care of connecting the recommendations to the evidence as identified consists of tissue debridement, control of persistent inflammation through the Registered Nurses’ Association of Ontario’s (RNAO) or infection, and moisture balance before considering advanced Nursing Best Practice Guidelines. To date, the RNAO has published therapies for wounds that are not healing at the expected rate. The three guidelines related to the treatment of wounds (pressure, venous best practice recommendations are based on scientific evidence and diabetic), and the components related to local wound care are and expert opinion, and should include patient preference. They are included in this review. Introduction he concept of Preparing the wound bed was first FIGURE 1 described in 2000 by Sibbald et al. and Falanga.1,2 This Preparing the Wound Bed Paradigm T approach to wound management stresses that successful diagnosis and treatment of patients with chronic wounds Person with a Chronic Wound require holistic care and a team approach. The whole patient must be considered before looking at the wound itself. Figure 1 illustrates that wound bed preparation is the promotion of wound closure through Treat the Cause Local Patient-centred diagnosis and appropriate treatment of the cause, attention to • Address causes Wound Care Concerns patient-centred concerns, and correction of the systemic and local and co-factors • Adherence to plan of care factors that may be delaying healing.
    [Show full text]
  • Best Practice in Wound Assessment
    Art & science tissue viability supplement Best practice in wound assessment Benbow M (2016) Best practice in wound assessment. Nursing Standard. 30, 27, 40-47. Date of submission: August 8 2015; date of acceptance: October 11 2015. Abstract increasing (Bennett et al 2004, Dowsett and Shorney 2010). Much of this expenditure comprises hidden Accurate and considered wound assessment is essential to fulfil costs. As Dowsett (2015) identified, the challenge for professional nursing requirements and ensure appropriate patient and healthcare providers is to balance demands for cost wound management. This article describes the main aspects of holistic efficiency with high quality outcomes for patients. assessment of the patient and the wound, including identifying patient Evaluating costs and successful management of risk factors and comorbidities, and factors affecting wound healing to wounds is not only about dressing choices, but also ensure optimal outcomes. the number of people with wounds, how long these have been present, any complications, the effect on Author the time spent by healthcare professionals and the Maureen Benbow Independent nursing consultant, Crewe, cost of hospital admission when management proves Cheshire, England. ineffective (Drew et al 2007). Correspondence to: [email protected] Keywords Patient assessment The best quality wound management is ineffective if acute wound, chronic wound, exudate, holistic assessment, the patient’s risk and other contributing factors are multidisciplinary working, pain, patient assessment, skin care, not considered during the assessment, along with wound assessment, wound care, wound management their involvement in and acceptance of treatment. Conditions such as diabetes, cardiovascular disease, Review respiratory disease, anaemia, immune disorders, All articles are subject to external double-blind peer review and renal failure and obesity, and concurrent systemic checked for plagiarism using automated software.
    [Show full text]
  • Wound Bed Preparation in Practice
    POSITION DOCUMENT Wound bed preparation in practice Wound bed preparation: science applied to practice Wound bed preparation for diabetic foot ulcers Wound bed preparation for venous leg ulcers MANAGING EDITOR Suzie Calne SENIOR EDITORIAL ADVISOR Christine Moffatt Professor and Co-director, Centre for Research and Implementation of Clinical Practice, Wolfson Institute of Health Sciences, Thames Valley University, London, UK CONSULTANT EDITOR Madeleine Flanagan Principal Lecturer, Department of Continuing Professional Development, Faculty of Health and Human Sciences, University of Hertfordshire, UK EDITORIAL ADVISORS Vincent Falanga Professor of Dermatology and Biochemistry, Boston University; Chairman and Training Program Director, Roger Williams Medical Centre, Providence, Rhode Island, USA Marco Romanelli Consultant Dermatologist, Department of Dermatology, University of Pisa, Italy J Javier Soldevilla Ágreda Professor of Geriatric Care, EUE University of La Rioja, Logroño, Spain Supported by an educational Luc Téot grant from Smith & Nephew. Assistant Professor of Surgery, University Hospital, Montpellier, France Peter Vowden Consultant in General Surgery, Department of Vascular Surgery, Bradford Royal Infirmary, UK Ulrich E Ziegler The views expressed in this Senior Consultant and Plastic Surgeon, Department of Plastic and Hand Surgery, University of publication are those of the Wuerzburg, Germany authors and do not necessarily reflect those of Smith & Nephew. EDITORIAL PROJECT MANAGER Kathy Day SUB-EDITOR Ann Shuttleworth DESIGNER
    [Show full text]
  • Occupational Therapy Skin Care Guideline
    Occupational Therapy Skin Care Guideline Best Practice for the Prevention and Treatment of Pressure Ulcers Created by the Occupational Therapists in Vancouver Coastal Health and Providence Health Care April 2008 OCCUPATIONAL THERAPY SKIN CARE GUIDELINE FOR VCH/PHC BEST PRACTICE FOR THE PREVENTION AND TREATMENT OF PRESSURE ULCERS ACKNOWLEDGEMENTS This guideline has benefited from the contributions of many occupational therapists. We would like to acknowledge the following contributors: Occupational therapists in Vancouver Coastal Health and Providence Health Care who participated in the Huddles and trialled the guidelines. Members of the Core Committee: Elaine Au Jeanette Boily Linda Boronowski Jo Clark Dawn Daechsel Guylaine Desharnais Sandy Leznoff Jenny Finnegan Members of the Equipment Group: Jeanette Boily Guylaine Desharnais Peter Haughton George Kokuryo Cheryl Sheffield Joanne Yip Members of the Documentation Group: Elaine Au Samantha Carter Jenny Finnegan Teresa Green Sandy Leznoff April 2008 2 of 53 OCCUPATIONAL THERAPY SKIN CARE GUIDELINE FOR VCH/PHC BEST PRACTICE FOR THE PREVENTION AND TREATMENT OF PRESSURE ULCERS TABLE OF CONTENTS Acknowledgements ................................................................................................................. 2 Table of Contents .................................................................................................................... 3 1.0 Purpose and Scope .......................................................................................................... 4
    [Show full text]
  • Triangle of Wound Assessment
    Triangle of Wound made Assessment © Wounds Asia | Mayeasy 2015 www.woundsasia.com chronic wounds, further exploration of assessment of the periwound Introduction skin and its relevance to wound progression needs to be considered Wound assessment is essential in informing the within the wound healing paradigm. selection of appropriate therapeutic strategies The periwound area has previously been defined as the area of to achieve clinical goals, e.g. wound healing and skin extending up to 4cm beyond the wound edge8; for some improved patient wellbeing. This Made Easy wounds damage may extend outward, whereby any skin under the describes a new approach to wound assessment dressing may be at risk of breakdown and should be included in that encourages clinicians to look beyond the any assessment. Frequent problems in the periwound area include wound edge to routinely assess and manage the maceration, excoriation, dry (fragile) skin, hyperkeratosis, callus and eczema. periwound skin using the new Triangle of Wound Assessment. While current tools offer a standardised approach to wound assessment, they focus on the wound itself and use limited Authors: Dowsett C (UK), Protz K (Germany), Drouard descriptors to describe the periwound area4. There is a need for an M (France), Harding KG (UK). Full author details can be easy-to-use wound assessment tool that fully integrates assessment found on page 6. of the periwound area into the wound healing paradigm5,9. Importance of wound assessment Wound assessment can be defined as information obtained using The Triangle of Wound Assessment observation, questioning, physical examination and clinical The Triangle of Wound Assessment is a new tool that extends the investigations in order to formulate a management plan1.
    [Show full text]